Department of Medical and Surgical Sciences, University of Bologna, Italy; Clinical Pharmacology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy.
Infectious Disease Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy.
Clin Microbiol Infect. 2023 Sep;29(9):1150-1158. doi: 10.1016/j.cmi.2023.02.024. Epub 2023 Mar 7.
The clinical usefulness of follow-up blood cultures (FUBCs) in gram-negative bloodstream infections (GN-BSIs) represents a debated issue.
To assess the impact on the clinical outcome of FUBCs in patients with GN-BSI and to predict risk factors for persistent bacteraemia.
PubMed-MEDLINE, Scopus, and the Cochrane Library Database were independently searched until 24 June, 2022.
Randomized controlled trials, prospective, or retrospective observational studies, including patients affected by GN-BSIs. Primary endpoints were in-hospital mortality rate, and persistent blood stream infections were defined as FUBC-positive for the same pathogen isolated from index blood cultures (BCs).
Hospitalized patients with documented GN-BSIs.
Performance of FUBCs (defined as subsequent BCs collected at least 24 hours after index BCs).
Quality of included studies was independently assessed according to the Cochrane Risk of Bias Tool and the Risk Of Bias In Non-randomized Studies of Interventions.
Meta-analysis was performed by pooling odds ratio (OR) retrieved from studies providing adjustment for confounders using random-effect model with the inverse variance method. Risk factors for persistent blood stream infections were also assessed.
A total of 3747 articles were screened, and 11 observational studies (6 assessing impact on outcome (N = 4631), and 5 investigating risk factors for persistent GN-BSI (N = 2566)), conducted between 2002 and 2020 were included. The execution of FUBCs was associated with a significantly lower risk of mortality (OR, 0.58; 95% CI, 0.49-0.70; I = 0.0%). The presence of end-stage renal disease (OR, 2.99; 95% CI, 1.77-5.05), central venous catheter (OR, 3.30; 95% CI, 1.82-5.95), infections due to extended-spectrum β-lactamase-producing strains (OR, 2.25; 95% CI, 1.18-4.28), resistance to empirical treatment (OR, 2.70; 95% CI, 1.65-4.41), and unfavourable response at 48 hours (OR, 2.99; 95% CI, 1.44-6.24) emerged as independent risk factors for persistent bacteraemia.
The execution of FUBCs is associated with a significantly low risk of mortality in patients with GN-BSIs. Our analysis could be useful to stratify patients at a high risk of persistent bacteraemia to optimize the use of FUBCs.
革兰氏阴性菌血流感染（GN-BSI）中进行后续血培养（FUBC）的临床实用性是一个有争议的问题。
评估 GN-BSI 患者 FUBC 对临床结局的影响，并预测持续性菌血症的危险因素。
PubMed-MEDLINE、Scopus 和 Cochrane 图书馆数据库于 2022 年 6 月 24 日独立检索。
随机对照试验、前瞻性或回顾性观察性研究，包括受 GN-BSI 影响的患者。主要终点是院内死亡率，持续性血流感染定义为 FUBC 阳性，与指数血培养（BC）分离的相同病原体。
有记录的 GN-BSI 住院患者。
进行 FUBC（定义为在指数 BC 后至少 24 小时采集的后续 BC）。
根据 Cochrane 偏倚风险工具和非随机干预研究的偏倚风险评估独立评估纳入研究的质量。
使用随机效应模型和逆方差法，对提供混杂因素调整的研究中提取的比值比（OR）进行荟萃分析。还评估了持续性血流感染的危险因素。
共筛选出 3747 篇文章，纳入了 11 项观察性研究（6 项评估对结局的影响（N=4631），5 项研究探讨持续性 GN-BSI 的危险因素（N=2566）），这些研究于 2002 年至 2020 年进行。执行 FUBC 与死亡率显著降低相关（OR，0.58；95%CI，0.49-0.70；I=0.0%）。终末期肾病（OR，2.99；95%CI，1.77-5.05）、中央静脉导管（OR，3.30；95%CI，1.82-5.95）、产超广谱β-内酰胺酶菌株引起的感染（OR，2.25；95%CI，1.18-4.28）、经验性治疗耐药（OR，2.70；95%CI，1.65-4.41）和 48 小时时不良反应（OR，2.99；95%CI，1.44-6.24）是持续性菌血症的独立危险因素。
在 GN-BSI 患者中，执行 FUBC 与死亡率显著降低相关。我们的分析可用于对持续性菌血症风险较高的患者进行分层，以优化 FUBC 的使用。
